2Shoulder Girdle BonesClavicle and ScapulaMove as a unit
3Scapula Key Bony Landmarks (Palpate) Glenoid FossaAcromion Process- continuation of the spine of scapula and located at the lateral end of the clavicleCoracoid Process- located just below the lateral end of the clavicleSpine of ScapulaLateral BorderMedial Border-vertebral borderInferior AngleSupraspinous Fossa- located superior to the spine of the scapulaInfraspinous Fossa- located inferior to the spine of the scapulaStudents stand up and palpate key bony landmarks on each other
7Scapulothoracic Joint Not a true synovial jointNo ligamentous supportSupported dynamically and moves on the rib cage by two muscles; serratus anterior and subscapularis
8Sternoclavicular Joint Clavicle articulates with sternumSynovial jointVery strong joint and dislocation is rare
9Acromioclavicular Joint Acromion process of scapula articulates with clavicleSustains great forcesCommonly injured by collision sports such as hockey, football, rugby, horseback riding, mountain biking
10Glenohumeral Joint Scapula articulates with head of humerus The joint contains a shallow socket called the glenoid fossaThe glenoid fossa is only one-fourth the size of the humeral head
11Movements of the Shoulder Girdle Protraction (Abduction)Retraction (Adduction)Upward RotationDownward RotationElevationDepressionAnterior Tilt
12Movements Focus on specific bony landmarks inferior angleglenoid fossaacromion processShoulder girdle movements = scapula movement
13Protraction (abduction) scapula moves laterally away from spinal columnRetraction (adduction)scapula moves medially toward spinal columnPair students up, perform movements of shoulder girdle while palpating scapula
14Upward Rotationturning glenoid fossa upward & moving inferior angle superolaterally away from spinal columnDownward Rotationreturning inferior angle inferomedially toward spinal column & glenoid fossa to normal position
15Elevationupward or superior movement, as in shrugging shouldersDepressiondownward or inferior movement, as in returning to normal position
16Anterior TiltRotational movement of scapula occurring during glenohumeral hyperextensionSuperior border moving anteroinferiorly & inferior angle moving posterosuperiorly
17Scapulohumeral Rhythm The coordinated movements of the scapula, clavicle, and humerusShoulder joint and shoulder girdle work together in carrying out upper extremity activitiesGlenohumeral movement requires the scapulothoracic, acromioclavicular, and sternoclavicular joints to also move
18Scapulohumeral Rhythm Scapula rotates 1o for every 2o movement of the humerus (Overall 2:1 ratio of glenohumeral to scapulothoracic movement)The scapula rotates 60 degrees, the humerus abducts 120 degrees , totaling 180 degrees of abduction at the GH joint
19Shoulder Joint Shoulder Girdle FlexionUpward Rotation and ElevationExtensionDownward Rotation and DepressionAbductionUpward RotationAdductionDownward RotationHorizontal AdductionProtractionHorizontal AbductionRetractionMedial RotationLateral Rotation
20Muscles that Move the Shoulder Girdle 5 muscles primarily involved in shoulder girdle movementsAll originate on axial skeleton and insert on scapula and/or clavicleDo not attach to humerus and do not cause shoulder joint actionsEssential in providing dynamic stability of the scapula so it can serve as a relative base of support for shoulder joint activities such as throwing, batting, and blocking
21Muscles that Move the Shoulder Girdle Posterior:Trapezius (upper, middle, and lower)Levator ScapulaRhomboids (minor and major)Anterior:Serratus AnteriorPectoralis Minor
22Trapezius OriginsUpper Fibers: Occipital Bone (skull) and Spinous Process of C7Middle Fibers: Spinous Process of T1-T5Lower Fibers: Spinous Process of T6-T12Ask students to abduct the shoulder and retract scapula to palpate
23Trapezius Insertions Upper Fibers: Lateral 1/3 of clavicle Middle Fibers:Acromion Process of ScapulaLower Fibers:Root of the Spine of Scapula
24Trapezius Actions Upper Fibers: Elevation of Scapula Middle Fibers: RetractionUpward Rotation of ScapulaLower Fibers:DepressionUpward rotation of Scapula
25Trapezius Integrated Functions Upper Fibers:Provide dynamic stability to the cervical spine and shoulderMiddle Fibers:Eccentrically decelerates scapular protractionAssists in dynamically stabilizing the scapulaLower Fibers:Eccentrically decelerates scapular elevation
26Levator Scapula Origin: Transverse Process of C1-C4 Insertion: Medial Border of ScapulaActions:Elevation of ScapulaDownward Rotation of ScapulaExtension of Head and NeckMost is deep to trapezius. When palpating relax trapezius. Downwardly rotate scapula and palpate superior to superior angle of scapula.
27Levator Scapula Integrated Functions Assists in eccentric deceleration of depression and upward rotation of scapulaAssists in eccentric deceleration of flexion of head and neckAssists in dynamic stabilization of the cervical spine and scapula
28Rhomboids Minor and Major Origin:Minor: Spinous Process of C7-T1Major: Spinous Process of T2-T5Insertion:Minor: Root of the Spine of the ScapulaMajor: Between the Root of the Spine of the Scapula and the Inferior Angle of the ScapulaDeep to trapezius. Downwardly rotate scapula and palpate between scapula and and spine (at level of inferior angle)
29Rhomboids Minor and Major Actions Retraction of ScapulaDownward Rotation of Scapula
30Rhomboids Minor and Major Integrated Functions Assists in eccentric deceleration of scapular protraction and upward rotation of scapulaAssists in stabilization of scapula
32Serratus Anterior Origin: Ribs 1-9 Insertion: Anterior surface of the medial border of scapulaActions:Protraction of ScapulaUpward Rotation of ScapulaMuch of it is deep to the scapula. Flex shoulder to 90 degrees. Between lateral borders of pec and lats and feel for the ribs and serratus anterior.
33Serratus Anterior Integrated Functions Assists in eccentric deceleration of retraction of scapulaAssists in stabilization of the scapulaHelps to hold the scapulothoracic joint along the medial border of the scapula
34Pectoralis Minor Origin: Ribs 3-5 Insertion: Coracoid Process of ScapulaActions:Protraction of ScapulaDepression of ScapulaDownward Rotation of Scapula
35Pectoralis Minor Integrated Functions Assists in eccentric deceleration of retraction of scapulaAssists in dynamic stabilization of the scapula
36Putting It All Together Scapular Elevation:Upper TrapeziusLevator ScapulaScapular Depression:Lower TrapeziusPectoralis MinorScapular Protraction:Serratus AnteriorPectoralis MinorScapuluar Retraction:Middle TrapeziusRhomboids
37Putting It All Together Scapular Upward Rotation:Serratus AnteriorUpper and Lower TrapeziusScapular Downward Rotation:RhomboidsLevator ScapulaPectoralis Minor
38Scapular WingingA winged scapula is a shoulder condition in which the scapula sticks out at the back, particularly when performing pushing exercises like the push up Common symptoms of a winged scapula include the following:Pain and limited shoulder elevationDifficulty in lifting weightsPressure on the scapulafrom a chair when sitting
39Scapular Winging A winged scapula can be caused by one of two reasons: Damage to the long thoracic nerve of the shoulder. It may cause paralysis of the serratus anterior. Medical clearance is necessary before engaging in any exerciseGeneral weakness of the serratus anterior muscle. In this case, the winging scapula can be improved with corrective exercises designed to build strength in the weak serratus anterior muscle.
40Three corrective exercises may strengthen serratus anterior: Scapular WingingThree corrective exercises may strengthen serratus anterior:Hand Walks, Arm Shuffle, Push Up PlusPay careful attention to scapulohumeral rhythm and symmetryMaintain a stable pelvis and neck
41Hand WalksThe pattern is one hand up, next hand up, one hand down, other hand down, repeat.
42Arm ShuffleBegin with your hands very wide. Shift your weight back and forth while simultaneously touching one hand on top of the other as shown
43Push Up PlusOnce you have completed a push up, add the “plus” motion by protracting your scapula as much as possible without changing your spinal alignment. Hands should be shoulder width apart.
44Rounded ShouldersA common postural condition in which the scapula are protracted and depressed and the humeri are medially rotatedWhen the trapezius muscles are weak they contribute to rounded shoulders because they are unable to efficiently oppose protraction of the scapula (especially if protractors pectoralis minor and serratus anterior are tight)
45Trapezius TightnessWhenever a phone is crimped between head and shoulder, it may cause tightness of the upper trapeziusWhenever a purse or book bag is carried upon the shoulder, people subconsciously elevate the scapula on the side which it is carried. This causes the elevators to isometrically contract for long periods of timeThis is another common posture that may cause tightness of the upper trapezius
46Rhomboids and Pectoralis Minor When rhomboids are weak they can contribute to rounded shoulders because they cannot oppose protraction and depression of the scapulaWhen pectoralis minor is tight, they can contribute to rounded shoulders
47Scapular Depression on Bench This is an exercise for individuals who need to work the lower traps, rhomboids, and serratus anterior musclesMaintain a tall posture throughout the exercise and good stability through the abdominal complex.
48Supine Row Lie under bar so that the bar is at mid-sternum level Activate core by drawing inPerform row and lift body towards the barThe bar should meet the mid-sternum.Lower slowlyAVOID retracting the scapula before pulling yourself up, it should be a smooth action through the scapulothoracic joint as you lift yourself towards the bar.
49Levator Scapula Stretch In the proper posture sit on a ball or chair with a minimum of 90 degrees bend at the hips and kneesDraw your belly button inward toward your spineTuck your chin in and rotate the head in right direction of your opposite pocket while retracting and depressing shoulder of the side being stretchedHold for seconds, repeat for 2-3 reps
50Upper Trapezius Stretch In optimal posture sit on the ball or bench with a minimum of 90 degree bend at the hips and knees.Draw your belly button inward toward your spineTuck your chin in and slowly draw your left ear to your left shoulder until tension is feltHold for seconds, repeat for 2-3 reps
51Foam Roll Rhomboids Draw your belly button inward toward your spine Stabilize the head in “neutral”Roll mid-back area on the foam rollIf a “tender point” is located, stop rolling, and rest on the tender point until pain decreases